Doppler Transmitral Flow Research Articles

Transmitral Doppler flow reflecting elevated pulsatility index in a HeartMate III assist device.

Transmitral Doppler flow reflecting elevated pulsatility index in a HeartMate III assist device.

Optimal Heart Rate May Improve Systolic and Diastolic Function in Patients with Fontan Circulation.

(1) Background: The optimal heart rate, at which the E-wave and A-wave stand adjacent without any overlaps in the Doppler transmitral flow echocardiography, is associated with maximum cardiac output and favorable clinical outcomes in adult patients with systolic heart failure. However, the clinical implication of the echocardiographic overlap length in patients with Fontan circulation remains unknown. We investigated the relationship between heart rate (HR) and hemodynamics in Fontan surgery patients with and without beta-blockers. (2) Methods and Results: A total of 26 patients (median age 1.8 years, 13 males) were enrolled. At baseline, the plasma N-terminal pro-B-type natriuretic peptide was 2439 ± 3483 pg/mL, the fraction area change was 33.5 ± 11.4%, the cardiac index was 3.55 ± 0.90 L/min/m2, and the overlap length was 45.2 ± 59.0 msec. Overlap length was importantly decreased after the one-year follow-up (7.60 ± 78.57 msec, p = 0.0069). Positive correlations were noted between the overlap length and A-wave and E/A ratio (p = 0.0021 and p = 0.0046, respectively). Ventricular end-diastolic pressure was significantly correlated with the overlap length in non-beta-blocker patients (p = 0.0483). (3) Conclusion: Overlap length may reflect the status of ventricular dysfunction. Hemodynamic preservation at lower HR could be critical for cardiac reverse remodeling.

Стресс-эхокардиография в диагностике кардиальной дисфункции в раннем постинфарктном периоде

The purpose — to assess the importance of stress echocardiography in identifying the nature and severity of cardiac dysfunction in patients with myocardial infarction. Material and methods.86 patients were examined at the outpatient stage of rehabilitation 6 weeks after myocardial infarction with primary coronary angioplasty with stenting. Results.Echocardiography revealed left ventricular hypertrophy (LVH) in 34 patients with myocardial infarction with concomitant arterial hypertension. Patients with LVH are characterized by more pronounced structural and functional LV remodeling, which is expressed in a lower LVEF and increased LVEDD, LVESVand LVEDV(p<0.05). There were no differences in stroke volume between patients with and without LVH. The performed diastolic stress test in patients with LVH is characterized by significantly lower average early diastolic mitral annular velocity e` (7.6 vs. 9.3 cm/s, p<0.01) without differences in the peak early transmitral Doppler flow velocity E (69.8 vs 78.0, p>0.05) compared with patients without LVH. The revealed differences between patients with and without LVH are due to a higher post-exercise velocity e` in patients with normal LV geometry and a decrease in eccentric LVH subgroup. Conclusions.1) Patients with LVH in the early postinfarction period (6 weeks) have more pronounced LV systolic dysfunction, expressed in a decrease in LVEF and an increase in LVEDD, LVESV, LVEDV compared to patients without LVH.2) Left ventricular hypertrophy, in conditions of myocardial infarction, is associated with latent diastolic dysfunction, which is manifested by a lower average early diastolic mitral annular velocity e` after the stress-test.

Abstract 12140: SCN1B Expression Modulates Sodium Influx in Cardiomyocytes and Diastolic Function in the Adult Heart

Voltage-gated sodium channels (VGSCs) are macromolecular complexes composed of a number of proteins regulating channel biophysical properties. VGSCs generate Na + current (I Na ) in myocytes and play fundamental roles in excitability and impulse conduction in the heart. Moreover, VGSCs condition mechanical properties of the myocardium, a process that appears to involve the late component of I Na . Variants in the gene SCN1B , encoding the VGSC β1 and β1B subunits, result in inherited neurological disorders and cardiac arrhythmias. But the precise contributions of β1/β1B subunits and VGSC integrity to the overall function of the adult heart remain to be clarified. For this purpose, adult mice with cardiac-restricted, inducible deletion of Scn1b (conditional knock-out, cKO) were studied. Myocytes from cKO mice had decreased levels of Scn1b transcripts (-85%) and increased densities of fast- (+20%) and slow-inactivating (+140%) components of I Na , with respect to cells from corresponding control (Ctrl) animals. By echocardiography, left ventricular (LV) mass, chamber volume, and systolic function were preserved in both male and female cKO mice, with respect to sex- and age-matched Ctrl animals. However, by transmitral flow Doppler echocardiography, cKO mice presented reduced velocity of the passive filling wave (-~20%), attenuated ratio of the passive-to-active filling velocity waves (-~20%), and prolonged isovolumic relaxation time (+~16%). Moreover, by pressure-volume (PV) loop assessment, cKO mice had steeper slope of the LV end diastolic PV relation and prolonged LV relaxation tau, suggesting impairment of diastolic function. Importantly, inhibition of late I Na with GS967 (0.5 mg/kg body weight) normalized left ventricular filling pattern and isovolumic relaxation time in cKO mice, but had no consequences in Ctrl animals. At the cellular level, cKO myocytes presented delayed kinetics of Ca 2+ transients decay and cell shortening with respect to Ctrl myocytes. These defects were partly corrected by inhibition of the late I Na . Collectively, these results document that VGSC β1/β1B subunits modulate electrical and mechanical function of the heart by regulating, at least in part, Na + influx in cardiomyocytes.

Abstract 17253: The Late Sodium Current Contributes to Electromechanical Defects Occurring With Aging

To establish the contribution of the late sodium current (I NaL ) on cardiovascular defects occurring with aging, mice with phosphomimetic mutation of Na + channel Nav1.5 at Ser571 (S571E), which causes I NaL enhancement in cardiomyocytes (I NaL gain-of-function), and mice with ablation of the Nav1.5 Ser571 (S571A), preventing CaMKII-mediated I NaL increase under stress condition (I NaL loss-of-function) were studied together with C57Bl/6 mice (wild-type, WT). Male mice at 2-6 (~4 m), 10-16 (~12 m), 17-20 (~18 m), and 20-27 (~24 m) months of age underwent electrocardiographic and echocardiographic evaluation. In WT mice, the QT interval duration of the ECG in the anesthetized state was similar at ~4 and ~12 months (56±5 ms and 58±5 ms, respectively) and was prolonged at ~18 and ~24 months (66±4 ms and 67±3 ms, respectively). In S571E mice, QT interval at ~4 months was prolonged with respect to WT animals (67±4 ms) and remained protracted at ~12, ~18, and ~24 months (65±3 ms, 68±6 ms, and 69±5 ms). S571A animals at ~4 months presented intermediate QT interval duration with respect to the other two strains (61±3 ms), and remained unchanged at ~12, ~18, and ~24 months (63±4 ms, 62±4 ms, and 64±4 ms). Ejection fraction was not altered with age and was comparable for the three mouse groups. In contrast, by transmitral flow Doppler echocardiography diastolic function, quantified here by the isovolumic relaxation time, was normal in WT mice at ~4 (17.4±1.6 ms) and ~12 months (16.8±1.6 ms) and became depressed at ~18 (21.5±2.5 ms) and ~24 months (21.4±1.7 ms). Defective diastolic function was apparent in S571E mice at ~4 months (19.7±2.9 ms) and persisted at ~12, ~18, and ~24 months (19.1±1.7 ms, 21.0±1.9 ms, and 22.1±2.2 ms, respectively). Interestingly, S571A mice at ~4 months had normal diastolic function (16.2±2.2 ms) and minor alterations were observed at ~12, ~18, and ~24 months (17.1±1.5 ms, 18.4±1.6 ms, and 19.3±3.3 ms, respectively). Overall, collected results suggest that I NaL enhancement in S571E mice is associated with premature appearance of prolonged electrical recovery and defective diastolic function, with respect to aging WT animals. In contrast, S571A mice, with inability to increase I NaL , are protected from electromechanical defects occurring with aging.

Left atrial function assessed by speckle tracking echocardiography in anthracycline-induced cardiotoxicity: a case report.

BackgroundThe onset prevention and early diagnosis in cardiotoxicity due to cancer chemotherapy are important, and it is important to detect cardiac dysfunction at an early stage and start treatment to enhance the therapeutic effect.Case summaryA 31-year-old female with breast cancer received chemotherapy with epirubicin (400 mg/m2) and cyclophosphamide followed by docetaxel. Two months after the initiation of her chemotherapy, the left ventricular (LV) ejection fraction (LVEF) determined by echocardiography fell to 41.2%, and she was diagnosed with cancer therapy-related cardiac dysfunction (CTRCD). Three months after the initiation of cancer treatment, the peak velocity of late diastolic transmitral Doppler flow (A wave) became undetectable. Peak longitudinal strain (LS) and peak LS rate, which reflect left atrium (LA) reservoir function, gradually declined like the LVEF and LV-global LS (GLS). Seven months after the initiation of cancer treatment, she was diagnosed with acute decompensated heart failure. The changes in peak LS and peak LS at the onset were greater than those in LVEF and LV-GLS.DiscussionThis is a case report suggesting that LA reservoir function might be a more sensitive indicator than LVEF or LV-GLS in detecting CTRCD and that LA booster function might be the earliest. Left atrium reservoir function might be a more sensitive than conventional LV pump function and optimal indicator in CTRCD.

Pirfenidone is Associated with Decreased Indexed End Diastolic and Systolic Volumes in Patients with HFpEF and a Known History of Idiopathic Pulmonary Fibrosis

Background To date, there remains to be a lack of effective treatment modalities for HFpEF, which accounts for approximately 50% of all cases of congestive heart failure. Pirfenidone is a novel anti-fibrotic agent that has been shown to improve pulmonary function in patients with Idiopathic Pulmonary Fibrosis. In pre-clinical studies, pirfenidone has been implicated in decreasing myocardial fibrosis and diastolic dysfunction (Kuwahara et al, Circulation 2002). The effects of this medication on markers of LV function and structure in humans with a history of IPF and HFpEF has not been studied. Hypothesis We hypothesize that patients taking pirfenidone will have favorable changes in echocardiographic parameters of LV function and structure. Methodology We performed a retrospective review of 24 patients with a history of HFpEF and IPF being treated with pirfenidone. All patients had pre and post treatment echocardiograms. Changes in parameters of LV structure (indexed LV mass, end diastolic and end systolic volumes), diastolic function (indexed left atrial volume, trans-mitral Doppler flow patterns, tissue Doppler indices), systolic function (EF) and global LV strain were compared before and after pirfenidone administration. Results mean age of patients involved was 70±6.8 years and patients were predominantly males(76%). 34% patients had a history of CAD, 62% HTN, 16% Atrial fibrillation, 61% hyperlipidemia, 23% diabetes, 25% CKD and 46% obesity. 88% of patients had stage 1 diastolic dysfunction at baseline and 12% with stage 2 diastolic dysfunction. Mean NT pro BNP was 2287±3444 pg/ml . Post pirfenidone treatment, there was a significant reduction in indexed LV end diastolic(-11.9±1.1ml/m2) and end systolic (-6.2±2.3ml/m2) volumes. No significant changes were noted in other parameters. Conclusion Treatment with pirfenidone was associated with decreases in indexed LV end diastolic and end systolic volumes in patients with HFpEF and a known history of IPF. However, contrary to the rest of the hypothesis, no improvements were noted in markers of LV diastolic, systolic function and strain. Our study was retrospective in nature and limited by its small sample size.

How to consider target heart rate in patients with systolic heart failure.

AimsHeart rate reduction therapy using ivabradine, a selective inhibitor of the funny current of the sinoatrial node, is widely used in the systolic heart failure cohort. However, the optimal target of heart rate remains controversial. The association between heart rate and ‘overlap’ between E‐wave and A‐wave in the pulse wave transmitral flow Doppler echocardiography might be a key to find the ideal heart rate in each individual.Methods and resultsWe performed transthoracic echocardiography in patients with systolic heart failure, and the association between heart rate, deceleration time, and overlap length between E‐wave and A‐wave was assessed. In total, 368 patients with systolic heart failure (median 76 years old, 190 men, median ejection fraction 40%) were included. The measured overlap length was 35 (−72, 115) ms. Given the results of multiple linear regression analyses, we constructed a formula: estimated overlap length (ms) = −589 + 6.2 × heart rate (bpm) + 0.81 × deceleration time (ms), which had a good agreement with actually measured one (r = 0.62). The ideal heart rate, at which the overlap length is ‘zero’ and probably cardiac output is maximized, is calculated as follows: ideal heart rate (bpm) = 93 – 0.13 × deceleration time (ms).ConclusionsWe proposed a novel formula using deceleration time to estimate ideal heart rate that achieves a zero overlap between E‐wave and A‐wave in patients with systolic heart failure. Prognostic impact of the formula‐guided heart rate optimization should be studied.

Guided therapy in patients with acute heart failure: left ventricular diastolic filling pattern and NT-proBNP

Aim: N-terminal pro B-type natriuretic peptide has been commonly used in acute heart failure. We investigated whether the Doppler transmitral flow parameters on admission and discharge offer a useful guide like N-terminal pro B-type natriuretic peptide levels in acute heart failure. Material and Method: This study with a prospective randomized design included 57 patients admitted to the emergency department between October 2019 and March 2020. All patients had New York Heart Association class IV, had sinus rhythm, and were diagnosed previously with dilate cardiomyopathy. The left ventricular diastolic filling pattern during admission and discharge was evaluated in all patients using transthoracic echocardiography. N-terminal pro B-type natriuretic peptide levels were analyzed on admission and discharge to compare the left ventricular filling pattern. Results: The average age of the patients was 64.94±5.56 years. During admission, the left ventricular filling pattern of all patients was of restrictive type (type III), whereas during discharge, 46 patients had abnormal relaxation (type I) and 11 patients had pseudonormal (type II) filling pattern. N-terminal pro B-type natriuretic peptide levels were 8004.75±743 pg/mL and 1645.17±104.58 pg/mL during admission and discharge, respectively. The mean e/e’ ratio of the patients was 14.83±0.25 and 7.70±0.14 and E/A ratio was 2.51±0.35 and 1.42±0.33 during admission and discharge, respectively. N-terminal pro B-type natriuretic peptide levels with regard to the mitral filling pattern were different during discharge. The N-terminal pro B-type natriuretic peptide level with an abnormal relaxation pattern was 1440.43±144.75 pg/mL and that with a pseudonormal pattern was 1957.60±64.00 pg/mL (p=0.003). Conclusion: Our study demonstrated that the left ventricular filling pattern successfully guided in acute heart failure therapy, similar to N-terminal pro B-type natriuretic peptide -guided therapy.

P2466The impact of circumferential pulmonary vein isolation on global and regional left atrial function in patients with paroxysmal atrial fibrillation

Abstract Introduction The effect of circumferential pulmonary vein isolation (PVI) for atrial fibrillation (AF) on left atrial (LA) function has not been well defined. Purpose The aim of this study was to evaluate the immediate impact of ablation on parameters of global and regional LA function using intracardiac echocardiography (ICE) Methods We studied 26 consecutive patients (age 56±10 years, 19 men) with paroxysmal AF using ICE before and immediately after circumferential PVI. All pulmonary veins were isolated in all patients. ICE measurements included LA fractional area shortening, peak A wave on transmitral Doppler flow, peak emptying velocity on the left atrial appendage (LAA) Doppler flow, as well as tissue Doppler myocardial velocities at the level of the posterior LA wall, interatrial septum, and lateral wall, which were used as parameters of regional LA function. Results The mean radiofrequency ablation time was 37±22min. Post ablation there was a significant reduction of the LA fractional area shortening from 27±8% to 22±6% (p<0.01). The tissue Doppler velocity of atrial contraction at the posterior wall decreased significantly post ablation: from 8.9±1.8 cm/s to 6.9±1.4 cm/s (p<0.01). There were no significant differences between the pre and post ablation values for tissue Doppler velocities at the level of the interatrial septum or LA lateral wall. The post ablation peak transmitral A wave and peak LAA Doppler velocities did not differ significantly from the pre ablation values. Conclusion In patients with paroxysmal atrial fibrillation, circumferential PVI results in an immediate decrease in LA function without a significant change in LAA function.

Responses to Pirfenidone Treatment in Patients with Idiopathic Pulmonary Fibrosis is Not Associated with Changes in Echocardiographic Parameters of Left Ventricular Structure and Function

Background Pirfenidone, an FDA-approved novel anti-fibrotic agent used in the treatment of idiopathic pulmonary fibrosis (IPF), has been implicated in mitigating myocardial fibrosis, systolic and diastolic dysfunction in animal models (Kuwahara et al, Circulation 2002). However to date, the effect of Pirfenidone on left ventricular (LV) structure and function in humans with IPF has not been studied. Hypothesis We hypothesize that changes in echocardiographic parameters of LV structure and function would be more favorable in responders compared to non-responders of pirfenidone in patients with IPF. Methods We performed a retrospective review of 27 consecutive patients with IPF on pirfenidone between 2014-2018 with serial baseline and follow up echocardiograms and pulmonary function testing. Treatment failure (non-response) was defined as an absolute decline in forced vital capacity (FVC) of more than 10% whilst being on the medication. Comprehensive echocardiographic data extraction and analysis was performed in all patients. Changes in parameters of LV structure (LV mass, interventricular septal and posterior wall thickness, indexed end systolic and diastolic volumes), systolic function (LVEF), diastolic function (Indexed left atrial volume, trans-mitral Doppler flow patterns, tissue Doppler indices) and global LV longitudinal strain were compared between responders and non-responders. Results In our study cohort, 18 responders and 9 non-responders were identified. Responders were significantly older than non-responders, yet sex, history of CAD, hypertension, diabetes, atrial fibrillation, CKD and cardiac medication use were not significantly different. Baseline echocardiographic parameters were comparable, except for septal e/e’, which was higher in responders (11.68 vs 10.1; p Conclusion In contrary to our hypothesis, we observed that response to pirfenidone therapy in patients with IPF did not associate with echocardiographic changes of left ventricle structure and function.

RISK FACTORS, CO-MORBIDITIES AND ECHOCARDIOGRAPHIC PROFILE IN MIDDLE-OLD HYPERTENSIVES

Objective: Epidemiological evidence suggests increasing proportion of elderly people. One half/two thirds of them have hypertension. The aim of the present study was to assess the risk factors, co-morbidities, and echocardiographic profile in middle-old hypertensives admitted in an Internal Medicine Departament Design and method: We enrolled 64 consecutive patients with hypertension and age between 75 and 85 years old. We retrospectively analyzed demographic, clinical and laboratory, (including thransthoracic echocardiographic parameters) features from the patient admission charts. The biochemical parameters investigated were: glucose plasma level, total, low and high density cholesterol, triglycerides, uric acid, GFR – MDRD equation. Results: 50 patients (78.1%) were females, and 14 (21.9%) males. 87.5% of patients had left ventricular concentric remodeling, and 90.6% had relaxation abnormalities assessed by pulsed Doppler transmitral flow. History of mellitus diabetes type 2 was recorded in 40.6%, ACS in 1.5%, chronic kidney disease in 23.4%, COPD in 18.7% and atrial fibrillation in 15.6%. 28.1% of the patients were overweight, and 46.8% obese. Hyperglycemia was found in 45.3% and hyperuricemia in 15.6%. Hyperlipidemia was present in 81.2% of middle-old hypertensives. In our study active smokers were 29.6% and former smokers 10.9%. Smoking was related to COPD. Conclusions: Middle-old hypertensives are mostly women, have important left ventricular concentric remodeling with diastolic dysfunction. Two third of patients had obesity or overweight, and third smokes. The frequent concomitant diseases were hyperlipidemia and diabetes. The risk factor correction and treatment of co-morbidities should be an important target in middle-old with hypertension.

Effects of oral trazodone on echocardiographic and hemodynamic variables in healthy cats.

The purpose of this study was to evaluate the effects of oral trazodone on echocardiographic variables, heart rate (HR) and blood pressure (BP) in healthy cats. Client-owned domestic cats between 2 and 8 years of age were recruited. Cats were considered healthy based on physical examination, complete blood count, blood chemistry profile, urinalysis, total thyroxine concentration, non-invasive BP measurement by Doppler method and a screening transthoracic echocardiogram with simultaneous electrocardiogram. Echocardiographic variables assessed pre-trazodone and 90-120 mins post-trazodone (50 mg PO) included left ventricular internal diameter in systole and diastole, interventricular septal and left ventricular free-wall thickness in systole and diastole, left atrial size, left auricular function and left ventricular diastolic function assessed by spectral Doppler transmitral and pulmonary venous flow velocities, and tissue Doppler profiles. Mean echocardiographic and hemodynamic variables were calculated for pre- and post-trazodone examinations for each cat. Pre- and post-trazodone variables were analyzed with a paired t-test with significance set at P <0.05. Twelve healthy cats were evaluated. Trazodone was administered to all cats and a sedative effect was observed. There were no clinically significant differences in any echocardiographic variables post-trazodone administration. Systolic BP was significantly decreased after trazodone (P = 0.001) with no significant change in HR. Trazodone did not alter echocardiographic variables, in a clinically relevant manner, in this group of healthy cats. Trazodone may aid in obtaining transthoracic echocardiograms without affecting HR or echocardiographic variables but may significantly lower BP in healthy cats.

Assessment of right ventricular function by echocardiography in patients with ischemic cardiomyopathy and non-ischemic cardiomyopathy

Left ventricle (LV), right ventricular (RV) structural and functional changes occurs in advanced heart failure (HF). Assessment of RV function is important as it has prognostic significance in prognosis. RV functions, depending on the underlying cause of ischemic cardiomyopathy (ICMP) or nonischemic cardiomyopathy(NICMP) are affected by different levels. Patients with clinical sign of HF and echocardiographic parameters as LVEF ≤ % 35 and LV end diastolic diameter (LVEDD) ≥ 55 mm, sinus rhythm (SR), clear image quality, absence or mild valve insufficiency were included in the study. The study consisted of 20 ICMP and 24 NICMP patients with LVEF < %35 and increased LV end-diastolic diameter (LVEDD > 5.5 cm), non severe valve disease and SR. RV and LV volume, diameter and function are assessed by echocardiography. Patients have similar basic characteristics. LV functions were evaluated by two-dimensional(2D) echocardiography, transmitral flow Doppler and tissue Doppler echocardiography and the analysis revealed similar results in both groups. RV longitudinal diameter in ICMP was significantly lower when compared to the NICMP(6.80 ± 0.83 cm, 7.4 ± 1.03 cm; p=0.03). Mean RVEF was comparable between groups and %59 in NICMP while 62% in ICMP. There were no significant differences between groups regarding RV transtricuspid flow Doppler parameters. In tissue Doppler parameters, lateral annulus Sm velocity which reflects RV systolic function was lower in ICMP than NICMP (0.09 ± 0.02 cm/sn vs 0.11 ± 0.018 cm/sn; p = 0.004). TAPSE assessed by M-mode echocardiography was significantly lower in ICMP group than NİCMP(1.98 ± 0.39, 2.28 ± 0.33; p = 0.009). The present study show that RV function was significantly decreased in ICMP when compared to NICMP.

Normal Reference Values for Assessing Diastolic Function Using the Parameterized Diastolic Filling Formalism Method in Patients with Normal Results of Rest and Stress Echocardiography

The parameterized diastolic filling (PDF) method can be used to study the mechanics of early diastolic left ventricular (LV) filling. However, there are no publications describing the reference ranges of the PDF parameters. This study retrospectively recruited patients with normal results on rest and stress echocardiography and no diabetes or hypertension (n=138, 45% female). DICOM images of the resting E-wave from transmitral pulsed wave Doppler flow velocities were analyzed using freely available software. Viscoelastic energy loss (c) and stiffness (k) were higher in males compared to females (p≤0.001 for both). There were no correlations between any of the PDF parameters and age (p>0.05 for all). In males, stiffness was correlated with systolic blood pressure (r=0.24, p=0.04), and load and filling energy were correlated with diastolic blood pressure (r=-0.27, p=0.02, and r=-0.29, p=0.01, respectively). Sex-specific normal 95% reference limits for PDF analysis of early LV filling are presented for clinical use.

Transmitral Doppler Flow Pattern in Left Atrial Myxoma.

Transmitral Doppler Flow Pattern in Left Atrial Myxoma.

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OBJECTIVES/SPECIFIC AIMS: Nonalcoholic fatty liver disease (NAFLD) affects 1 in 3 Americans and can exist in 2 histological subtypes: simple hepatic steatosis (SHS) and nonalcoholic steatohepatitis (NASH), a clinically aggressive variant. Fatigue is the most common complaint in patients with NAFLD but the etiology of fatigue is unknown. Thus, the goal of this study was to objectively evaluate fatigue via maximal cardiopulmonary exercise testing and identify determinants of exercise intolerance in NAFLD. METHODS/STUDY POPULATION: In total, 14 subjects with histologically confirmed NAFLD were prospectively enrolled. Subjects with cirrhosis or those with known history of heart failure (systolic or diastolic) were excluded. Fatigue was quantified via the Duke Activity Status Index (DASI) questionnaire. A symptom-limited treadmill cardiopulmonary exercise test was performed in all subjects to measure exercise time (ET) and peak oxygen consumption (peak VO2). Doppler-echocardiography was performed to measure systolic and diastolic function. RESULTS/ANTICIPATED RESULTS: The DASI score and ET was significantly reduced in patients with NASH (n=10) when compared to those with SHS [40.2 (IQR=24.2–50.7) vs. 58.2 (IQR=50.7–58.2), p=0.04]; [9.1 (IQR=6.4–12.2) vs. 13.1 (IQR=12.5–13.1) min, p=0.02, respectively] reflecting moderate fatigue and impaired overall exercise capacity. The ET was directly linked to peak VO2 (R=+0.79, p&lt;0.001), VO2 at anaerobic threshold (R=+0.73, p=0.003), and inversely to ventilatory efficiency index (R=−0.785, p=0.001) suggesting impaired cardiorespiratory fitness in those with reduced ET. ET was also linked to several parameters of diastolic dysfunction including left atrial volume index (R=−0.798, p&lt;0.001), and the ratio of early transmitral pulse-wave Doppler flow velocity (E) to early mitral annulus tissue Doppler velocity E’ (E/E’) (R=−0.608, p=0.036), suggesting a role of diastolic dysfunction in patients with NAFLD with exercise intolerance. DISCUSSION/SIGNIFICANCE OF IMPACT: Cardiac abnormalities drive cardiorespiratory fitness and exercise intolerance in patients with NAFLD. These findings are exaggerated in patients with NASH suggesting a link between disease severity in NAFLD, exercise intolerance and diastolic dysfunction.

Left ventricular diastolic dysfunction in patients with ST-elevation myocardial infarction following early and late reperfusion by coronary intervention

BackgroundThis study prospectively assessed the left ventricular (LV) diastolic function changes in patients with ST-elevation myocardial infarction (STEMI) and determined if the early revascularization of the infarct-related coronary artery in acute phase achieve a better recovery of diastolic function than late recanalization. MethodsForty-five consecutive patients (61.20±11.37years, 8 females) presenting with STEMI and treated with PCI were prospectively enrolled in this study. The important inclusion criteria were first acute coronary syndrome episode and LV ejection fraction exceeded 45%. The patients were divided to two different groups by total ischemia time (TIT): early reperfusion (TIT<6h) and late reperfusion group (TIT≥6h). Transthoracic echocardiography were performed within the first week after PCI, and data were compared between groups. Evaluation of diastolic function was based on integrated assessment of trans-mitral Doppler flow pattern, tissue Doppler, and color M-mode ECT. ResultsA normal diastolic filling pattern was seen in only 9 patients, and the other 80% patients had abnormal filling patterns: 16 impaired relaxation, 14 pseudonormal, and 6 restrictive filling patterns. The e′septal velocity was lower in early reperfusion group compared to late reperfusion group (5.52±1.67cm/s vs 7.11±2.14cm/s, P<0.05), but no statistical difference was found in E/e′ average (11.99±4.30 vs 9.85±3.47, P>0.05). There was also no statistical difference for left atrial volume index and mitral annulus propagation velocity between groups. ConclusionsLV diastolic dysfunction was present in most of acute MI patients even after successful PCI. It seemed STEMI patients receiving early myocardial reperfusion had no better diastolic functions compared with late-reperfused patients within the acute phase.

Diagnostic utility of contemporary echo and BNP assessment in patients with acute heart failure during early hospitalization

BackgroundThe use of B-type natriuretic peptide (BNP) and echocardiography in acute heart failure (AHF) diagnosis is poorly employed in the Emergency Department. The aim of the present study is to evaluate relation among BNP levels systolic and diastolic dysfunction during early phases of AHF hospitalization. MethodsWe performed contemporary echocardiographic and BNP assessment in 310 patients with AHF within 12h since hospital admission. We studied the correlation among BNP and degree of diastolic dysfunction evaluated by pulsed Doppler transmitral flow and Tissue Doppler flow. Finally we investigated the relation among BNP and the right systolic longitudinal ventricular function (TAPSE) and the systolic pulmonary arterial pressure (PAPs). ResultsBNP levels were 1417±1126, 1081±955, 894±901pg/mL, for patients with EF≤25%, EF 25–40% and EF 40–50% (p=0.005), respectively. “BNP levels linearly correlate with the degree of diastolic dysfunction: 582±406pg/mL in altered relaxation pattern, 712±557pg/mL in pseudonormal pattern and 1694±805 in restrictive filling pattern (p<0.001 for all patterns).” BNP levels were significantly increased in patients with right systolic ventricular dysfunction (TAPSE<18mm; p=0.006) and in patients with PAPs≥40mmHg (p=0.001). ROC curve and logistic regression analysis highlighted the power of BNP to detect severe systolic dysfunction, right ventricular (RV) overload and dysfunction and diastolic dysfunction patterns. ConclusionsBNP levels correlate linearly with LV systolic dysfunction as well as with impaired degree of diastolic dysfunction. Significant PAP increase is a further factor influencing BNP elevation in patients with AHF during early hospitalization phase.

Abstract 18996: Impact of Infarct Size on Left Ventricular Diastolic Function Following Acute Myocardial Infarction

Introduction: Severe left ventricular diastolic dysfunction is associated with worse prognosis after acute myocardial infarction (MI). Twenty percent of patients have a restrictive filling pattern (RFP) following MI, and this is associated with a fourfold increase in mortality. The determinants of diastolic function in this setting are not well defined. Aim: We sought to determine the correlation between enzymatic infarct size and RFP in patients with a first ever MI. We hypothesized that a larger infarct size would result in greater impairment of left ventricular diastolic function. Methods: Data analysis was performed on consecutive patients admitted with first ever non-ST elevation MI (NSTEMI) or ST-elevation MI (STEMI) to a single large tertiary referral hospital from January 2013 to December 2014. All patients underwent coronary angiography during the index admission. Infarct size was determined by peak troponin I. Doppler transmitral flow pattern was obtained from the initial transthoracic echocardiogram performed within 48 hours of admission. RFP was defined as: E/A ratio &gt;2.0 and/or E-wave deceleration time &lt;160ms (American Society of Echocardiography Guidelines 2009). Results: Data were available on 645 consecutive patients who underwent coronary angiography for MI. We excluded 160 patients with a previous MI. Of the remaining 485 patients (mean age 62±13 years; mean left ventricular ejection fraction (LVEF) 53±12%), there were 338 NSTEMIs (70%) and 147 STEMIs (30%). PCI was performed in 360 (74%) patients (single vessel (82%), ≥2 vessels (18%)); coronary artery bypass surgery in 58 (13%); and medical management in 67 (13%). Sixty-nine patients (14.4%) had RFP; 52% of these had a LVEF ≥45%. Peak troponin I levels were higher in the RFP group (31.8±30.9μg/L vs 16.8±25.2μg/L, p=&lt;0.001). On multivariate analysis, infarct size by peak troponin I (OR 1.02, 95%CI 1.00-1.03, p=0.026) and low LVEF (OR 0.95, 95%CI 0.91-0.99, p=0.015) were the only independent predictors of RFP. Conclusion: Infarct size was a major determinant of diastolic dysfunction following first ever MI. Whilst LV systolic dysfunction was strongly associated with impaired diastolic function, 52% of patients with severe diastolic dysfunction had relatively preserved LVEF.